Credentialing Specialist

3 days ago


Phoenix, Arizona, United States Imsaz Full time
Job Summary

We are seeking a highly organized and detail-oriented Credentialing Specialist to join our team at IMS. As a Credentialing Specialist, you will be responsible for performing and maintaining timely, accurate, and complete third-party payor credentialing and hospital privileging for assigned IMS providers.

Key Responsibilities
  • Verify provider status and ensure accurate and timely submission of third-party payor credentialing/recredentialing and hospital privileging information/applications to external designees.
  • Provide day-to-day tasks of provider status verification, external or internal correspondence, department organization, including provider files and filing, mail management, and utilizing and maintaining the credentialing database.
  • Proactively provide and/or timely respond to requests regarding the active credentialing and hospital privileging status of IMS providers to internal and external customers, as per the policies and procedures of the department.
  • Maintain the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (if applicable), and IMS's policies and procedures.
  • Actively participate in departmental meetings, payor meetings, and with departmental process and procedure development and modifications.
  • Participate as directed in annual location site reviews.
  • Use technology to maximize process work efficiencies and effectiveness.
  • Complete IMS mandatory training.
  • Participate in new department employee orientation, training, and development as requested.
  • Perform other duties as assigned.
Requirements
  • High school diploma or GED required.
  • AA degree preferred.
  • 2-4 years minimum experience required, specifically medical office and physician and hospital credentialing, 1-3 years minimum experience required, specifically medical office/physician billing and insurance claim follow-up and denial management.
  • Knowledge of health plan websites, CAQH, Intelli App software program, licensing boards, NPPS (NPI), Medicare (PECOS), National Provider DB, and hospital CVO's required.
  • Excellent oral and written communication skills.
  • Strong interpersonal skills, ability to get along well with others; team player.
  • Demonstrated ability to maintain confidentiality.
  • Strong organizational skills; able to handle a variety of tasks and prioritize.
  • Goal orientation; excellent follow-through.
  • Self-motivated; self-starter.
  • Detail-oriented.
  • Pro-active.
  • Demonstrates willingness to accept responsibility and accountability for assigned tasks.
  • The ability to work in a constant state of alertness and in a safe manner.
What We Offer

We offer a generous compensation package including medical, dental, vision, short-term and long-term disability, life insurance, paid time off, and a very lucrative 401k plan.

IMS is a tobacco-free work environment and an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity, age, protected veteran status, or any other characteristic protected by law.



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